Cost & Insurance Coverage

You may be able to get NEXPLANON for free.*

*Check with your insurance provider about coverage and cost. You may have a deductible, co-pay, or other charges.

The cost of NEXPLANON depends on your insurance plan. You may be able to get NEXPLANON for free, as a result of changes under the Affordable Care Act. Check with your insurance plan for cost and coverage information. You may need to pay a co-pay, deductible, or other charges.

Insurance Coverage for NEXPLANON

Once you and your doctor have decided that NEXPLANON is right for you, check with your insurance provider to determine your specific coverage.

NEXPLANON may be covered as a medical benefit or as a pharmacy benefit. To find out if you have coverage for NEXPLANON as a medical benefit:

Step 1:

Call the customer service number listed on the back of your health insurance card. Be sure to write down the names of any people you speak with.

Step 2:

Tell the representative that NEXPLANON is a physician-administered birth control drug (not a device) and that your physician will:

  • Be prescribing NEXPLANON
  • Order NEXPLANON for you
  • Insert NEXPLANON during an office visit

Step 3:

Ask the representative if NEXPLANON is covered.

If the answer is “no,” ask if you have coverage for NEXPLANON as a pharmacy benefit.

To get information about your pharmacy benefit, you may have to call another number (such as the pharmacy customer service number on the back of your health insurance card) and speak to a different person.

Repeat steps 1-3.

If NEXPLANON is covered:

Step 1:

Ask the representative whether NEXPLANON and the insertion procedure are 100% covered. If not, ask about your out-of-pocket costs. You should also ask your health care representative about coverage and out-of-pocket costs for removal, keeping in mind your insurance may change.

Step 2:

Ask the person to send verification of coverage to your health care provider, if possible.

Step 3:

If written verification cannot be provided, write down the name of the person you spoke with and tell your health care provider that your health plan told you what you’ve learned about your coverage.

Step 4:

Make an appointment with your health care provider to have NEXPLANON inserted.

If NEXPLANON is not covered:

Step 1:

Ask your health plan representative if there are circumstances under which a "medical exception" would be authorized, and let your health care provider know what you have learned.

Step 2:

If medical exception is not available, tell your health care provider whether you would be willing to pay the full cost of NEXPLANON out-of-pocket. You can also ask your health care provider about payment plans that may be available.


 

NEXPLANON is a prescription medication for the prevention of pregnancy in women.

IMPORTANT SAFETY INFORMATION

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please read the accompanying Patient Information for NEXPLANON and discuss it with your health care provider. The physician Prescribing Information also is available.



 
 

This site is intended only for residents of the United  States, its territories, and Puerto Rico. Copyright © 2018  Merck Sharp & Dohme B.V., a  subsidiary of  Merck & Co., Inc. All rights reserved.  WOMN-1161698-0022 09/18 WOMN-1161698-0022 09/18